Keeping Dr. Google under control: how to prevent and manage cyberchondria
Authors: Vladan Starcevic
Journal: World Psychiatry (2023)

The Internet has become the main source of health information, which is usually obtained via online health search using relevant engines – a behavioral pattern also known as "Dr. Google". Online health search has had an empowering effect, allowing an easy access to hitherto difficult-to-find health information. However, it can also become problematic and lead to cyberchondria. Cyberchondria is an excessive and/or repeated online health search that is associated with increased distress or health anxiety and persists despite interference with functioning and negative consequences1. The latter may include disruptions in the relationships with physicians and in the usual patterns of seeking and receiving health care2. It has been suggested that cyberchondria represents a compulsive form of "problematic usage of the Internet"3, with the key issue being a precarious control over online health search. This search is driven by a need to alleviate health anxiety, which however increases with persisting search, and then spirals out of control4. Studies have confirmed strong relationships between cyberchondria and health anxiety, problematic Internet use, and symptoms of obsessive-compulsive disorder1. Prevention of cyberchondria may entail improvement in online health information literacy, because people with greater literacy have been found to have lower levels of cyberchondria5. A specific approach to prevention requires addressing the factors that increase the risk of cyberchondria, including erroneous expectations of the Internet, poor coping with information overload, uncertainty, and confusion about trustworthiness of the sources of online health information4. A prevention program needs first of all to clarify what the Internet can and cannot do. It is important to debunk unrealistic expectations, e.g., that the Internet can provide definitive explanations for all health-related queries. Accumulation of information does not necessarily translate to a better understanding or more knowledge. In the context of online health search, having more information does not equate to also having an explanation, for instance a diagnosis. Attempting to diagnose oneself via Dr. Google should be discouraged, because it can spiral out of control, cause more distress and thus lead to cyberchondria. Second, an abundance of online health information (information overload) during online health search, especially when that information is inconsistent or conflicting, can lead to a sense of being "stuck" or losing control whilst performing the search. Providing education about the effects of information overload and improving coping with this overload may afford protection against cyberchondria. Third, an adequate uncertainty management may also play an important role in preventing cyberchondria. Online health information is often ambiguous and can be confusing, thereby amplifying uncertainty. Intolerance of such uncertainty and trying to cope with it through further search to arrive at a "closure" (e.g., a diagnosis) opens a pathway to a vicious cycle of reassurance seeking. Therefore, if online health search makes no progress and seems to only generate distress, the strategy needs to change and relevant health information should be obtained from an alternative source, including one's physician. Fourth, an ability to distinguish between trustworthy and untrustworthy sources of online health information provides an additional layer of security when engaging in online health search. Health information obtained from reputable sources (e.g., academic and research organizations or governments) is usually more trustworthy, although it may be "impersonal". Health information found in forums and blogs often reflects personal experience and may be valuable as such, but it is not necessarily applicable to others. People with cyberchondria usually do not seek help for it directly, perhaps because of the perception that this is not a "recognized" condition. Instead, they tend to present to clinical services with hypochondriasis, anxiety disorders, problematic Internet use or even "Internet addiction". Largely due to cyberchondria's ambiguous conceptual status and its relatively "hidden" nature, approaches to its management are still in their infancy. Management of cyberchondria should be based on an understanding of each person's circumstances. In other words, why is that person presenting with cyberchondria at this particular time? What precipitated cyberchondria and what is its purpose? Is it a specific symptom or health concern that initiated online health search, and is the person primarily seeking reassurance? What are the consequences of cyberchondria and how has one's life changed because of excessive online health search? For example, has the person been avoiding his/her doctor or visiting the doctor too often? Why does excessive online health search persist despite the problems it has caused? Is it because the search is experienced as a way of coping with uncertainty? Answers to these questions are likely to shape the management approach and determine treatment targets. Common treatment targets in cyberchondria include certain facets of psychopathology (e.g., health anxiety and obsessive-compulsive symptoms), personality traits (e.g., perfectionism, trust/mistrust imbalance, intolerance of uncertainty, and poor time management), behavioral responses to anxiety-provoking or distressing stimuli (e.g., reassurance seeking or avoidance), information management issues (e.g., poor coping with abundant or conflicting online health information), and specific aspects of the interactions with computers and the Internet (e.g., unrealistic expectations of the Internet or assumption that the order in which the results of online health search are presented reflects the likelihood of these results providing an explanation for health-related queries). These targets can be addressed using a combination of educational and psychotherapeutic approaches. Existing psychotherapeutic methods can be adapted to treat cyberchondria. One study has demonstrated that a modified Internet-delivered cognitive-behavior therapy (CBT) for hypochondriasis/health anxiety that also addressed cyberchondria was efficacious in the treatment of both6. In that study, cyberchondria-specific components of CBT included measures that improved online health information literacy and psychoeducation about ways of making search productive and avoiding excessive and unnecessary search. Cyberchondria is increasingly regarded as a public health problem3, which is uniquely and largely related to its potential to affect health care. In view of this recognition, developing prevention and management programs for this condition and testing their efficacy should be prioritized.